Empirical Study On Rural Resident’s Health Inequalities In Three Counties,Shandong

BackgroundAccording to United Union’s statistics, although global average life expectancy rose remarkably, health inequalities exist abroad across different countries, regions and races. In2005, World Health Organization established the commission on social determinants of health devoting to explore social factors influencing population’s health. It leads each country to find out sources of health inequalities and formulate related policies to improve health equity. Since reform and open policy, our economy grows rapidly, meanwhile income disparity is broadened. Dual economic structure of urban and rural areas has never been eradicated and difference of socioeconomic strata is becoming more significant. Consequently, income-related inequalities are increasingly serious.ObjectiveTo explore factors and sources of health inequalities multi-dimensionally and prioritize them based on the analysis of self-assessed health data coming from rural residents in Zhangqiu, Pingyin and Jiaxiang of Shandong Province, we propose relevant and targeted policies, reduce health inequalities and improve overall health status of rural residents.MethodsData comes from a household survey in the project "Micro-insurance and daily life care service in Shandong province". The combination of stratification and cluster sampling method was adopted in the survey, including2068individuals in4villages from3counties; however, we only brought788residents who completed health self-assessment in to this research. Conducting descriptive statistics, univariate statistical inference (x2test) and Logistic regression etc., we analyzed overall health status, physical strength and social communication of rural residents with different demographic characteristics and socioeconomic status, in order to explore socioeconomic factors related to health. In addition, the research measures degree of health inequalities with CI and its decomposition approach helps us to find out sources of health inequality.Results(1) x2test of self-assessed over health, physical strength and social communication on each included factors shows that gender, age, education level, occupation, marital status, income, household scale and cooking energy are generally statistically significant, while insurance status is not.(2) Good overall health rate is59.39%, good physical strength rate is56.35%and individuals whose social communication is influenced by health and emotion status accounted for27.92%. There is comparatively high consistency between them,65%-80%. χ2test proves significance and Cramer’s Vs are between0.30-0.60, indicating moderate correlations.(3) CIs for good overall health, physical strength and communication are0.074,0.112and0.037, respectively. Three positive CIs demonstrate that the rich tends to have a higher health status than the poor in rural areas of Shandong Province, namely, the existence of health inequalities. Among them, self-assessed physical strength has the largest degree of inequality, while social communication is of the lowest.(4) All included factors’CIs reflect females, old age, low education level, farmers, the divorced/widowed, bad living environment are characteristics of economically disadvantaged population.(5) Income level, age, cooking energy and education level are main sources of health inequalities. Consequently, socioeconomic status cannot be ignored in creating health disparities.Conclusions(1) There are pronounced health inequalities in Shandong rural areas.(2) Income plays its role on rural residents’health through Psycho-social path and Material path, making the largest contribution to health inequalities.(3) Rural residents are generally of relatively lower education level, education length are strongly related to self-assessed overall health and social communication and its contribution is just smaller than income, however, marginal diminishing effect is significant.(4) Living environment’s (cooking energy) contribution remains stable for health inequalities measured by different index, and there is an obvious "energy ladder" in rural areas.(5) Demographic variables’contributions, to some degree, are reasonable, and age’s contribution is larger than gender.(6) Physical health&social health affect and improve each other, determining individual’s overall health status.Policy Implications(1) Strengthen health education in order to improve rural residents’health accomplishment.(2) Advocate clean energy utilization and improve rural residents’living environment.(3) Narrow income disparity and pay more attention to social well-being of the disadvantaged.(4) Enrich rural residents’life and enhance communication among people of the neighborhood.(5) Strive to develop community health service facilities in rural areas and improve essential medical and public health service.